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Navitus exception coverage form 2026

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The document is a request form for exceptions to coverage by Navitus Health Solutions, detailing the necessary information and criteria for various types of medication requests, including quantity limit increases, gender-specific medications, new drugs, high doses, and not covered drugs. It outlines the required patient and prescriber information, rationale for the request, and instructions for submission.

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Click ‘Get Form’ to open the navitus exception coverage form in the editor.
Begin by entering the date at the top of the form. This helps track when the request was made.
Fill in the prescriber’s name, NPI, phone number, and fax number. Accurate contact information is crucial for follow-up.
Provide patient details including their name and date of birth to ensure proper identification.
Select the request type from options such as Quantity Limit Increase or New Drug. Be sure to provide a clinical rationale for your choice.
In the 'Requested Drug Information' section, specify the drug name, strength, frequency, and quantity needed.
If applicable, complete the formulary alternatives table with any alternatives tried and their outcomes.
Finally, ensure that you sign and date the form before submission to validate your request.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an exception to coverage form?

An exception request is a type of coverage determination. An enrollee, an enrollees prescriber, or an enrollees representative may request a tiering exception or a formulary exception.

What is an exception request in health insurance?

You can get an exemption so that you wont have to pay a penalty for not having qualifying health insurance. Some exemptions require an exemption application through Covered California. Other exemptions do not require an application: Instead, you can claim them when you file your state tax return.

Does Navitus cover Wegovy for weight loss?

Certain weight loss medications are not required to be covered and Wegovy is not currently covered. What conditions / drugs commonly required prior authorization or step therapy? Call Navitus at 1.866.

What is the exception to coverage in Navitus?

The Exception to Coverage (ETC) process allows members to request coverage of medications that show formulary restrictions. The ETC form cannot be used to request copay lowering or coverage of a direct plan exclusion.

What is an exception to coverage?

An exception request is a type of appeal that you can file with your health insurance company when a medication is not covered on the list of drugs covered by your plan, also known as a formulary.

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Is Navitus owned by Costco?

Navitus Health Solutions, owned by SSM Health and Costco Wholesale Corporation, was founded in 2003 as an alternative to traditional pharmacy benefit manager (PBM) models. Navitus approaches pharmacy services fundamentally differently.

Navitus exception coverage form 2026

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